(Circulation. 1998;98:2709-2715.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Regular Physical Exercise Corrects Endothelial Dysfunction and Improves Exercise Capacity in Patients With Chronic Heart Failure
Presented in part at the 70th Scientific Sessions of the American Heart Association, Orlando, Fla, November 9–12, 1997 and published in abstract form (Circulation. 1997;96[suppl I]:I-638.)
From the University of Leipzig, Heart Center, Department of Internal Medicine/Cardiology, Leipzig, Germany.
Correspondence to Priv-Doz Dr med Rainer Hambrecht, Herzzentrum der Universität Leipzig, Klinik für Kardiologie Russenstr 19, 04289 Leipzig, Germany. E-mail hamr{at}server3.medizin.uni-leipzig.de
Background—The purpose of this study was to determine the effects of systemic exercise training on endothelium-mediated arteriolar vasodilation of the lower limb and its relation to exercise capacity in chronic heart failure (CHF). Endothelial dysfunction is a key feature of CHF, contributing to increased peripheral vasoconstriction and impaired exercise capacity. Local handgrip exercise has previously been shown to enhance endothelium-dependent vasodilation in conduit and resistance vessels in CHF.
Methods and Results—Twenty patients were prospectively randomized to a training group (n=10, left ventricular ejection fraction [LVEF] 24±4%) or a control group (n=10, LVEF 23±3%). At baseline and after 6 months, peak flow velocity was measured in the left femoral artery using a Doppler wire; vessel diameter was determined by quantitative angiography. Peripheral blood flow was calculated from average peak velocity (APV) and arterial cross-sectional area. After exercise training, nitroglycerin-induced endothelium-independent vasodilation remained unaltered (271% versus 281%, P=NS). Peripheral blood flow improved significantly in response to 90 µg/min acetylcholine by 203% (from 152±79 to 461±104 mL/min, P<0.05 versus control group) and the inhibiting effect of L-NMMA increased by 174% (from -46±25 to -126±19 mL/min, P<0.05 versus control group). Peak oxygen uptake increased by 26% (P<0.01 versus control group). The increase in peak oxygen uptake was correlated with the endothelium-dependent change in peripheral blood flow (r=0.64, P<0.005).
Conclusions—Regular physical exercise improves both basal endothelial nitric oxide (NO) formation and agonist-mediated endothelium-dependent vasodilation of the skeletal muscle vasculature in patients with CHF. The correction of endothelium dysfunction is associated with a significant increase in exercise capacity.
Key Words: endothelium-derived factors • nitric oxide • skeletal muscles • oxygen uptake • blood flow
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S. Adamopoulos, J. Parissis, D. Karatzas, C. Kroupis, M. Georgiadis, G. Karavolias, J. Paraskevaidis, K. Koniavitou, A. J. S. Coats, and D. T. Kremastinos Physical training modulates proinflammatory cytokines and the soluble Fas/soluble Fasligand system in patients with chronic heart failure J. Am. Coll. Cardiol., February 20, 2002; 39(4): 653 - 663. [Abstract] [Full Text] [PDF]
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M. de Lorgeril, P. Salen, M. Accominotti, M. Cadau, J.-P. Steghens, F. Boucher, and J. de Leiris Dietary and blood antioxidants in patients with chronic heart failure. Insights into the potential importance of selenium in heart failure Eur J Heart Fail, December 1, 2001; 3(6): 661 - 669. [Abstract] [Full Text] [PDF]
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A. Maiorana, G. O'Driscoll, C. Cheetham, L. Dembo, K. Stanton, C. Goodman, R. Taylor, and D. Green The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes J. Am. Coll. Cardiol., September 1, 2001; 38(3): 860 - 866. [Abstract] [Full Text] [PDF]
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J. Bauersachs, I. Fleming, D. Fraccarollo, R. Busse, and G. Ertl Prevention of endothelial dysfunction in heart failure by vitamin E: Attenuation of vascular superoxide anion formation and increase in soluble guanylyl cyclase expression Cardiovasc Res, August 1, 2001; 51(2): 344 - 350. [Abstract] [Full Text] [PDF]
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P. V. Ennezat, S. L. Malendowicz, M. Testa, P. C. Colombo, A. Cohen-Solal, T. Evans, and T. H. LeJemtel Physical training in patients with chronic heart failure enhances the expression of genes encoding antioxidative enzymes J. Am. Coll. Cardiol., July 1, 2001; 38(1): 194 - 198. [Abstract] [Full Text] [PDF]
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L TAVAZZI and P GIANNUZZI Physical training as a therapeutic measure in chronic heart failure: time for recommendations Heart, July 1, 2001; 86(1): 7 - 11. [Full Text] [PDF]
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R. Belardinelli, I. Paolini, G. Cianci, R. Piva, D. Georgiou, and A. Purcaro Exercise training intervention after coronary angioplasty: the ETICA trial J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1891 - 1900. [Abstract] [Full Text] [PDF]
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S Adamopoulos, J Parissis, C Kroupis, M Georgiadis, D Karatzas, G Karavolias, K Koniavitou, A.J.S Coats, and D.T. Kremastinos Physical training reduces peripheral markers of inflammation in patients with chronic heart failure Eur. Heart J., May 1, 2001; 22(9): 791 - 797. [Abstract] [PDF]
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A.C. Mendes Ribeiro, T.M.C. Brunini, J.C. Ellory, and G.E. Mann Abnormalities in L-arginine transport and nitric oxide biosynthesis in chronic renal and heart failure Cardiovasc Res, March 1, 2001; 49(4): 697 - 712. [Abstract] [Full Text] [PDF]
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A. Linke, N. Schoene, S. Gielen, J.u. Hofer, S. Erbs, G. Schuler, and R. Hambrecht Endothelial dysfunction in patients with chronic heart failure: systemic effects of lower-limb exercise training J. Am. Coll. Cardiol., February 1, 2001; 37(2): 392 - 397. [Abstract] [Full Text] [PDF]
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Recommendations for exercise training in chronic heart failure patients Eur. Heart J., January 2, 2001; 22(2): 125 - 135. [PDF]
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T. Rankinen, T. Rice, L. Perusse, Y. C. Chagnon, J. Gagnon, A. S. Leon, J. S. Skinner, J. H. Wilmore, D. C. Rao, and C. Bouchard NOS3 Glu298Asp Genotype and Blood Pressure Response to Endurance Training : The HERITAGE Family Study Hypertension, November 1, 2000; 36(5): 885 - 889. [Abstract] [Full Text] [PDF]
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A. Maiorana, G. O'Driscoll, L. Dembo, C. Cheetham, C. Goodman, R. Taylor, and D. Green Effect of aerobic and resistance exercise training on vascular function in heart failure Am J Physiol Heart Circ Physiol, October 1, 2000; 279(4): H1999 - H2005. [Abstract] [Full Text] [PDF]
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C. A. DeSouza, L. F. Shapiro, C. M. Clevenger, F. A. Dinenno, K. D. Monahan, H. Tanaka, and D. R. Seals Regular Aerobic Exercise Prevents and Restores Age-Related Declines in Endothelium-Dependent Vasodilation in Healthy Men Circulation, September 19, 2000; 102(12): 1351 - 1357. [Abstract] [Full Text] [PDF]
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J. Bauersachs, D. Fraccarollo, P. Galuppo, J. Widder, and G. Ertl Endothelin-receptor blockade improves endothelial vasomotor dysfunction in heart failure Cardiovasc Res, July 1, 2000; 47(1): 142 - 149. [Abstract] [Full Text] [PDF]
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A. Maiorana, G. O'Driscoll, C. Cheetham, J. Collis, C. Goodman, S. Rankin, R. Taylor, and D. Green Combined aerobic and resistance exercise training improves functional capacity and strength in CHF J Appl Physiol, May 1, 2000; 88(5): 1565 - 1570. [Abstract] [Full Text] [PDF]
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Y. Tanabe, M. Takahashi, Y. Hosaka, M. Ito, E. Ito, and K. Suzuki Prolonged recovery of cardiac output after maximal exercise in patients with chronic heart failure J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1228 - 1236. [Abstract] [Full Text] [PDF]
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R. Hambrecht, L. Hilbrich, S. Erbs, S. Gielen, E. Fiehn, N. Schoene, and G. Schuler Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation J. Am. Coll. Cardiol., March 1, 2000; 35(3): 706 - 713. [Abstract] [Full Text] [PDF]
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R. Hambrecht, A. Wolf, S. Gielen, A. Linke, J. Hofer, S. Erbs, N. Schoene, and G. Schuler Effect of Exercise on Coronary Endothelial Function in Patients with Coronary Artery Disease N. Engl. J. Med., February 17, 2000; 342(7): 454 - 460. [Abstract] [Full Text] [PDF]
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M. R. Rinder, R. J. Spina, and A. A. Ehsani Enhanced endothelium-dependent vasodilation in older endurance-trained men J Appl Physiol, February 1, 2000; 88(2): 761 - 766. [Abstract] [Full Text] [PDF]
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A. Lavrencic, B. G. Salobir, and I. Keber Physical Training Improves Flow-Mediated Dilation in Patients With the Polymetabolic Syndrome Arterioscler Thromb Vasc Biol, February 1, 2000; 20(2): 551 - 555. [Abstract] [Full Text] [PDF]
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T. Munzel and D. G. Harrison Increased Superoxide in Heart Failure : A Biochemical Baroreflex Gone Awry Circulation, July 20, 1999; 100(3): 216 - 218. [Full Text] [PDF]
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P. G. Snell and J. H. Mitchell Physical Inactivity : An Easily Modified Risk Factor? Circulation, July 6, 1999; 100(1): 2 - 4. [Full Text] [PDF]
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